COOK, BRUCE R.
DIONNE, ETHAN J.
GRILLO, PETER J.
KARANTH, KOTA SADASHIVA
M.D., M.S., F.R.C.S.
LAPIERRE, ROBERT J.
MILLER, ROBERT A.
Our neurosurgeons work closely with our neurologists, physiatrists and pain specialists to provide comprehensive care for patients with conditions that affect the brain, spine and peripheral nerves.
Our expertise in the diagnosis and treatment of neurosurgical diseases is available right here in the Merrimack Valley. We perform surgeries at the Lawrence General Hospital, Holy Family Hospital, Lowell General Hospital, and Lowell General – Saints Campus. We coordinate with primary care physicians and specialists such as oncologists, radiation oncologists, endocrinologists, rheumatologists and other surgeons to help patients who choose to have their neurosurgical care locally. In cases wherein local resources become inadequate, patients are referred to tertiary care centers.
We rely on the best available imaging technology such as functional MRI, tractography, spectroscopy, and PET/CT scans, to facilitate diagnosis. We use the Brainlab image-guidance system to accurately localize brain tumors. Electrophysiologic monitoring during surgery, such as SSEP, MEP, and EMG, is available to ensure the best possible surgical outcome.
We understand that the decision to undergo surgery may be difficult. We welcome patients who are seeking another opinion regarding surgical treatment. We will thoroughly review the treatment options that may be considered for each patient.
The following are some of the surgeries that we perform:
- Biopsy of the brain, nerve, muscle or Lumbar fusion, ALIF, DLIF, TLIF, PLIF bone of the spine
- Lumbar interspinous decompression
- Carpal tunnel release with X-stop
- Cervical disc arthroplasty Microdiscectomy, cervical (anterior or posterior), thoracic or lumbar
- Cervical laminoplasty
- Minimally Invasive Spine Surgery
- Cervical fusion, anterior or posterior approach Minimally Invasive Sacroiliac Joint
- Microvascular decompression for Craniotomy for clipping of aneurysm trigeminal neuralgia
- Craniotomy for evacuation of brain
- Occipitocervical fusion bleed
- Odontoid screw fixation
- Craniotomy for resection of brain tumor Percutaneous trigeminal rhizotomy
- Implantation of deep brain stimulator Posterior fossa decompression for Chiari malformation
- Implantation of intrathecal pump (morphine or baclofen) Stereotactic Radiosurgery
- Implantation of spinal cord stimulator Transsphenoidal pituitary surgery
- Implantation of vagus nerve Ulnar nerve decompression stimulator
- Ventriculoperitoneal shunt
- Laminectomy for stenosis or spine tumors
Some of Our Services
Treatment of Brain Disorders
The neurologists and neurosurgeons of NENA work in a cooperative effort to diagnose and treat patients who may present with a variety of brain disorders, including brain tumors, blood vessel disorders, Chiari malformation, hydrocephalus, and those caused by trauma and infection. We also perform surgeries to treat movement disorders, seizure disorders and trigeminal neuralgia.
We have extensive experience in the evaluation and treatment of brain tumors. Surgery may involve brain biopsy, partial or total removal of the tumors. During surgery, we utilize a computerized neuronavigation system to accurately localize the tumor. This allows for small incisions and minimal manipulation of the brain. Functional MRI that localizes the areas of the brain responsible for speech and movement, and tractography that identifies the interconnections of the fibers in the brain, are available when needed to minimize the risks of tumor removal. MRI spectroscopy can measure the chemical makeup of brain tumors and help differentiate these from stroke, demyelinating disease, radiation necrosis or infection.
The collaboration between our neurosurgeons and the local oncologists and radiation oncologists ensures the best possible care for our patients with brain tumors. In certain patients with malignant brain tumors, radioactive seeds are implanted at the time of surgery to improve the delivery of radiation and the local control of the tumor. Post-operative radiation and chemotherapy are available locally.
We treat a variety of tumors including meningioma, glioblastoma multiforme, lymphoma, metastasis, vestibular schwannoma, astrocytoma, oligodendroglioma, colloid cyst, craniopharyngioma, pituitary tumors and ependymoma.
Blood Vessel Disorders
We treat patients who have disorders of the blood vessels in the brain. They may present with bleeding in the brain or seizures. Experts in stroke management and surgical intervention are available locally to help these patients, aided by a full complement of tests, including CT, MRI and angiography. An abnormal outpouching of the artery called an aneurysm may require emergent surgery if it ruptures. Congenital abnormality of the blood vessels called arteriovenous malformation (AVM) may require surgical resection. Inaccessible AVM's may be treated with radiosurgery.
Chiari malformation is a condition wherein part of the cerebellum descends through the opening of the skull. This may be associated with hydrocephalus or syringomyelia. Patients may present with headache, neck pain, or unsteadiness. Symptomatic patients usually benefit from removal of part of the skull in the back of the head and suturing of a synthetic membrane over the cerebellum.
Functional Neurosurgery for Movement Disorders
We work with neurologists to evaluate and treat patients with Parkinson's Disease, essential tremor, multiple sclerosis and other movement disorders. Treatment options include medications, Botox, and deep brain stimulation (DBS). We have been performing functional neurosurgery since 1994. This involves the alteration of brain functions by means of electrical stimulation or lesioning of a specific area of the brain. Implantation of the deep brain stimulator electrode is guided by high resolution MRI that localizes brain targets and refined using sophisticated electrode brain mapping to ensure the highest likelihood of success.
Head injuries are common and affect people of all ages. They are recognized as a major public health issue. Our surgeons evaluate and treat all kinds of head injuries, ranging from concussion to contusion, intracranial bleeds and skull fractures. Surgeries are also performed to relieve the compression on the brain caused by blood clots or brain swelling. We repair skull fractures and debride the brain if necessary. For those with severe brain injuries, we insert a monitoring device to help us treat the patient's condition more effectively. We work with a multispecialty team approach to maximize the chances of neurologic recovery for every patient with head injury. Comprehensive brain injury rehabilitation services are available locally. We also evaluate and treat sports related head injuries. We are available to recommend the timing of return to normal activities and sports after a head injury.
Accumulation of cerebrospinal fluid (CSF) in the brain may require a shunting procedure to divert the CSF and decrease the pressure within the brain. We use a variety of shunts including programmable shunts. We evaluate and treat patients who may have normal pressure hydrocephalus. These patients usually present with gait disturbance, urinary incontinence and dementia.
We work with local endocrinologists to diagnose and treat pituitary tumors. Some of these tumors can be treated with medications. When surgery is indicated, we perform a transsphenoidal removal of these tumors using microsurgical and endoscopic tools, guided by intra-operative fluoroscopy or neuronavigation.
Patients who cannot tolerate anticonvulsants, respond poorly to them or have intractable seizures are sent by NENA epileptologists for implantation of a vagus nerve stimulator (VNS). This device is programmable to deliver electrical impulses to the left vagus nerve in the neck. This may reduce the frequency, intensity or duration of the seizures, and the patient's dependence on anticonvulsants. We implant the electrodes in the neck and the generator in the left side of the chest. The procedure is done under general anesthesia. The patient is usually discharged on the same day. The epileptologist programs the stimulator two weeks after the implantation.
We work with local radiation oncologists to offer this treatment option to patients with brain tumor, AVM, or trigeminal neuralgia.A frame is attached to the patient's head and MRI and CT images are obtained.The target is then outlined in these images by using a computer. Radiation is delivered from a linear accelerator to the target with surgical precision, avoiding unnecessary damage to the surrounding healthy tissues. A frameless stereotactic radiosurgery system is also be available locally. This can be used to treat patients with spinal metastatic tumors.
Trigeminal neuralgia is a very painful condition affecting the face. This may be caused by tumors, multiple sclerosis, or blood vessels compressing the trigeminal nerve near the brainstem. In patients who cannot tolerate or fail to respond to medications, other treatment options may be considered. We perform percutaneous trigeminal rhizotomy using glycerol or a balloon catheter to destroy the painful nerve, microvascular decompression to relieve the pressure on the trigeminal nerve that is causing the pain, and radiosurgery to destroy the painful nerve. The treatment is individualized for each patient.